The first Rostrum took place in 1954 and involved delegates from the German, French, Belgian and Swiss national broadcasting companies. From then until 2002 the Rostrum's sessions were held at UNESCO's headquarters in Paris, with the exception of 2000 when they were hosted by Muziek Groep Nederland and the Gaudeamus Foundation in Amsterdam. Since 2003, a rotation system has been in place, where the Rostrum is hosted every other year by Radio France and in the intervening year visits a European venue.

Over thirty national radio networks now send delegates, presenting in total sixty or so works each year that have been composed no more than five years previously. Following sessions of listening and discussion, the delegates highlight one of the works submitted (that year's "selected work") and recommend a number of the others. They also highlight one or two works by composers under the age of thirty and recommend one or two others. These selected and recommended works are those most likely to be broadcast or played in concerts sponsored by the participating networks or others that follow the Rostrum's deliberations. All works presented are offered by the European Broadcasting Union to its members via satellite. Copies of recordings, scores and notes featured during the forum are kept at the Gaudeamus Foundation.

From 1991 until 2003 the composer of each year’s selected work was awarded the UNESCO Mozart Medal. Since 2004 the composer of each year’s selected work is awarded the UNESCO Picasso-Miró Medal and the composer or composers under the age of thirty whose work or works are selected are awarded the Guy Huot Bursary for young composers.